Heart Failure - What it is Show
Heart failure (also known as congestive heart failure) happens when the heart becomes weak or stiff, thus losing its ability to pump enough blood. This causes a build-up of fluid in the tissues (an oedema), leaving the organs and tissues with insufficient oxygen and nutrients to function properly. With lifestyle modifications and medications, the heart can pump blood better.
While heart failure can occur at any age, it tends to occur more frequently in elderly patients. In comparison to the Western population, the onset of heart failure in Singapore occurs at a younger age. In Singapore, the average age of onset for heart failure is at 50 years old, as compared to 60 years old in the West. A significant number of heart failure patients also have pre-existing medical conditions such as diabetes mellitus. Classifying Heart FailureThe heart function is determined by its ejection fraction and diastolic function. Ejection fraction is a measure of the percentage of blood leaving the left ventricle of the heart each time it contracts to supply the vital organs, while diastolic function is the measure of heart muscle relaxation to allow it to fill with blood. The assessment of the heart function can be performed using transthoracic echocardiogram or cardiac magnetic resonance imaging (CMR). There are different types of heart failure, whereby heart failure can be classified into two main groups. 1) Heart failure with reduced ejection fraction (HFrEF)This occurs when the left ventricle does not contract effectively and less blood is pumped out to the body compared to a normal functioning heart. In HFrEF (also known as systolic heart failure), the pump function of the heart is weakened and the organs do not receive enough oxygen. Patients usually have a left ventricle ejection fraction of less than 40% and this could be due to other factors, including coronary artery disease, infections, medications and hereditary conditions. 2) Heart failure with preserved ejection fraction (HFpEF) This occurs when the heart muscle contracts normally, however, the left ventricle is not able to relax and properly fill with blood during ventricular filling, resulting in ineffective pumping of blood around the body. In HFpEF (also known as diastolic heart failure), the systolic heart function is normal (left ventricle ejection fraction of 50% and above), however the heart muscle is stiff. Consequently, there is ineffective filling up and pumping of blood around the body. Stiffness of the heart muscle can occur due to a variety of reasons such as ageing, long-standing high blood pressure or obesity. Heart Failure - SymptomsThe symptoms of heart failure include:
Heart Failure - How to prevent?Heart failure is highly preventable and many of its common causes can be avoided with simple lifestyle modifications. Adopt a healthy lifestyle to prevent and control risk factors of coronary artery disease (diabetes mellitus, hypertension, hyperlipidaemia, smoking and obesity), which is the most common cause for heart failure. Other ways to prevent heart failure include:
Recommended servings of various types of food (Click to expand)
Heart Failure - Causes and Risk FactorsThe most common risk factors of heart failure are:
Heart failure can be precipitated by several events. The common precipitating factors are:
Heart Failure - Diagnosis
The diagnosis of heart failure is based on: 1) Symptoms:Symptoms can provide important clues to the presence of heart failure. Shortness of breath while engaging in activities and episodes of shortness of breath during sleep are classic symptoms of heart failure 2) Physical examination:The signs of heart failure can be detected in a physical examination. The doctor looks for distended or bloated neck veins, displacement of the heart pulse on
the chest, and swelling in the legs & tummy. With the use of a stethoscope, the doctor can listen for crackles in the lungs which suggest fluid build-up. The doctor might press on the abdomen to check if the liver is enlarged. The skin of the fingers and toes may have a bluish tint and feel cool if not enough oxygen is reaching them. 3) Tests:
During the diagnosis of heart failure, the doctor will usually be able to determine how serious the patient’s condition is.
Heart Failure - TreatmentsA variety of treatment methods are available to manage and prevent one’s condition from progressing. Heart failure is usually treated with lifestyle changes, medicines and procedures or surgeries. Lifestyle changes
Appropriate exercise such as
walking, cycling, swimming, or low-impact aerobic exercises may be recommended. However, it is important for heart failure patients to create an exercise programme with guidance from their doctors. The National Heart Centre Singapore (NHCS) offers a Cardiovascular Rehabilitation and Preventive Cardiology Programme for patients identified to
have multiple risk factors for heart disease or who have just undergone an open-heart surgery. The programme includes supervised exercise programmes, to help patients in their recovery journey.
Dietary
changes to maintain proper weight and reduction of salt intake may be needed. Reducing salt intake helps to lessen swelling in the legs, feet and abdomen
MedicationGenerally, the medications prescribed for heart failure help to:
Individuals should consult their doctor for the suitable medications for their heart failure condition. Procedures or SurgeriesSurgery may be needed to correct abnormalities of the heart or heart valves that cause heart failure. Congenital heart defects and abnormal heart valves can be repaired with surgery. Blocked coronary arteries can usually be treated with angioplasty or coronary artery bypass
surgery.
An angioplasty may be recommended for patients who have blocked arteries. This procedure is usually performed in the cardiac catheterisation laboratory, where a stent is expanded across a coronary blockage with a balloon. The balloon is deflated and removed, leaving the stent to keep the artery open. A stent is inserted into the narrow or blocked artery to open it up and improve blood flow
A coronary artery bypass surgery might be recommended if blocked arteries are causing your heart to fail. This involves taking a healthy blood vessel from another part of your body, such as the leg, arm or chest wall, and connecting it above and below the blocked arteries in your heart. This allows blood to flow around the blockage.
For patients with severe heart failure that cannot be treated with medications or surgery, doctors might recommend replacing the damaged heart with a healthy one.
Faulty heart valves affect the regulation of blood flow inside the heart,
putting additional strain on your heart. As such, doctors might recommend repairing or replacing the valve. This can be done in a variety of ways – an open heart surgery, minimally invasive surgery or cardiac catheterisation. Heart devicesSevere or end-stage heart failure may cause extensive damage to the heart muscles which cannot be treated with conventional medication and procedures. In such cases, patients are usually considered for mechanical assist devices.
When patients suffer from heart failure, the two ventricles in the heart might no longer be contracting in synchronisation. The CRT emits electrical signals to ensure the ventricles contract at the same time, thus allowing the heart to beat more systematically and efficiently.
Heart
failure patients with low ejection fraction are at risk for life threatening arrhythmias (abnormal heart rhythm). The role of an ICD is to monitor the heart rhythm and if it detects these dangerous arrhythmias, it will deliver a shock to stop the risky rhythms. Implantable cardioverter defibrillator’s components and functions
The VAD is usually recommended for patients with severe heart failure and are either unsuitable for a heart transplant or are waiting for a suitable donor. The VAD pumps blood from the lower chambers of the heart (ventricles) to the aorta, effectively replacing the pumping action of the heart to
maintain blood circulation. National Heart Centre Singapore (NHCS) Heart Failure ClinicThe clinic adopts a team approach to treat heart failure through a structured outpatient programme to prolong survival, improve quality of life and reduce hospital admissions. A specialist nurse clinician is on hand to provide phone consultations to patients.
Heart Failure - Preparing for surgeryHeart Failure - Post-surgery careHeart Failure - Other InformationHow do I care for someone with heart failure?
What happens in advanced heart failure?Advance Care Planning is important for heart failure patients to make plans about their future health care, especially when they are not in a position to make or communicate their healthcare choices. Shared decision-making among patients, their families and the medical team in establishing the goals of care should be initiated early. Unlike cancer patients, some heart failure patients can experience an unpredictable pattern of decline. Learn more on Advance Care Planning at NHCS here. When should you see a doctor?If you have been experiencing the symptoms of heart failure for a prolonged period of time or your symptoms are worsening, please visit a GP (general practitioner). Please proceed to the Emergency Department immediately if you experience sudden, severe symptoms. Videos on heart failure: 心脏衰竭患者 / Living with Heart Failure (Chinese version) Health Management Guide for Heart FailureRelated Health Articles
The information provided is not intended as medical advice. Terms of use. Information provided by What is the main cause of congestive heart failure?The most common cause of congestive heart failure is coronary artery disease. Risk factors for coronary artery disease include: high levels of cholesterol and/or triglyceride in the blood. high blood pressure.
How do you know if someone is in congestive heart failure?Buildup of excess fluid in body tissues (edema)
swelling in the feet, ankles, legs or abdomen or weight gain. You may find that your shoes feel tight. As blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing fluid to build up in the tissues.
What is the first stage of congestive heart failure?Congestive heart failure stages. What is the difference between heart failure and congestive heart failure?Heart failure often refers to early-stage weakening of the heart without congestion. As the damage to the heart progresses, it causes fluid to build up in the feet, arms, lungs, and other organs, which is referred to as congestion, throughout the body. This stage of heart failure is called CHF.
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